HomeMy WebLinkAbout250 CHINQUAPIN AVE; ; SE658572; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
qr~SEWER
PERMIT - APPLICATION
SEP 1M 65 !EM21756******5000
FOR APPLICANT TO FILL IN
r-PAIO
LEGAL
DESCRIPTION LOT NO /
m ^
BLOCK -2? TRACT^t^StA^fK* if^Zt
USE OF O\ S
BUILDINGS fi 51*C-^. -
CONTRACTOR /!_-» ^'i^i^-^^L^^
L ADDRESS
W CITY
CONTRACTOR S STATE
LICENSE NO
NO DESCRIPTION OF
TEL NO
CARLSBAD BUSINESS
LICENSE NO
WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 OO
SEPTIC TANK SEEPAGE PIT OR
PITS @ $5 OO
OVERFLOW SEEPAGE PIT DRAINFIELD EXTN
CESSPOOL DRYWELL MANHOLE @ $S OO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 SO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 SO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2 OO
@ $
OWNER S
^ AUTHORIZATION
P! HAVE AT THIS DATE A
1 CONTRACTOR TO CONNEC
ING TO THE PUBLIC SEW
SIGNED THIS
OWNER OR
OWNER S AGENT -. • •
ADDRESS —
PERMIT $
TOTAL FEE
&
z
s-i>
OO
&*»
CONTRACT WITH THE HEREIN
T THE ABOVE DESCRIBED BUILD
ER
. DAY OF -
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS t
BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL /
OWNER OF THE ABOVE DESCRIBED RESIDEXJCl/tL/PROP-//
ERTY 1 — ft Z7 ,) /I/
SIGNATURE ^f^Jr/TiSlA1! 6 Si fV /0C0 'Ctf
9 /
[
BUILDING .n ^—s* j^
ADDRESS -^~*3 I-* (j^
NEAREST &L j
CROSS ST ^ftfj>-Ss
OWNER j&£-4*-4?&. £.
MAIL ' f^f jf^m jS ^ A
ADDRESS Jf^lf^ (*£
CITY
T^L^J^^^I
, S^eS '
i^^sV ^Vs^f^^^~^*^ '
TEL NO
CONNECTION DATA
Lateral Charge Computation
30 H 10 V <S> 4' — A" —
Add Vert @ 4' —
Total
10% Service Charge
To
Lat No
b —
Construction Cost
tfll Lateral P.hnrgB
Logged in Plat
LINE COST DATA
A D & Assmt No
LINE COST
C C ® / / dwelling ,s5"Z?
P S @ / dwelling
OTHFR
FOR SEWER
St
ENGINEERING
S.rjned
TOTAI
LOCATION
NORTH
SEWER DEPT
Signed
5.00
This is a Sewer Permit When Properly Filled Out Signed and Validated
Issued By
PERMIT VALIDATION